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Newborn feet.

The opioid epidemic has touched every stage of life, including those who are pregnant and their babies.

Neonatal abstinence syndrome, or NAS, occurs when an infant is born having been exposed to opiates and experiences withdrawal symptoms after birth. Opiates include drugs such as codeine, oxycodone, methadone, subutex, heroin, and morphine.

The dramatic rise in NAS is linked with the increased use of opioids by those who are pregnant. According to the Centers for Disease Control and Prevention, from 1999 to 2013 the number of babies born in the United States with NAS increased 300% to nearly 6 per 1,000 hospital births.

Physical therapists help children with neonatal abstinence syndrome in the hospital right after birth. They also work with them after discharge to help them achieve developmental milestones and reach their full potential. 

Physical therapists are movement experts who improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation. To locate a physical therapist in your area, visit Find a PT.

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Signs and Symptoms

Babies born with NAS show signs of nervous system, stomach and intestines, and respiratory system problems. They are the result of the infants' immediate lack of addictive opioids after birth. Infants with NAS often have the following symptoms of withdrawal:

  • High-pitched crying.
  • Shaking/jitteriness.
  • Fussiness.
  • Stiffness in arms, legs, back.
  • Stuffy nose/sneezing.
  • Vomiting/diarrhea.
  • Feeding difficulties.
  • Poor weight gain.
  • Rapid breathing.
  • Stomach gas/cramping.
  • Skin issues around the bottom.
  • Trouble calming and sleeping.


Newborns with NAS need medication and help from a variety of health care professionals. Specially trained physical therapists are an integral part of the team for infants with NAS.

In the Hospital

Infants with withdrawal symptoms may need to stay in the hospital. They also may receive treatment in the neonatal intensive care unit.

Physical therapist treatment for babies with NAS may include:

  • Identifying the risk for delays in natural growth and development (developmental delays).
  • Managing the baby's environment. This can include:
    • Ensuring dim lighting and a quiet room.
    • Assisting with sleeping patterns.
    • Introducing sensory inputs slowly.
    • Minimizing brisk or startling movements.
  • Educating caregivers about infant stress cues. Cues an infant is under stress can include:
    • Looking away from the observer.
    • Arching the neck and back.
    • Making frantic and excessive movements
    • Frequent hiccups, sneezing, or yawning.
  • Helping caregivers recognize engagement clues. Cues an infant is ready to interact may include looking at caregivers, bringing hands to mouth, and snuggling. Using a pacifier can help with calming. Blankets can help make infants feel "contained" to decrease excessive movements.
  • Hands-on care (therapeutic touch) and movement experiences.
  • Helping to improve food intake. Treatment can include recognizing infant sucking patterns, using pacifiers, and other methods to strengthen the baby's ability to take a bottle or breastfeed successfully.
  • Family education. Physical therapists play a vital role in providing personalized caregiver education. They help parents understand their infant’s behavior cues.

After Discharge From the Hospital

The physical therapist in the NICU often bridges support for the infant and family as they leave the hospital and begin community-based services. Physical therapy is an important part of the infant's life as they transition into childhood.

An infant with NAS may need extra care after going home, including:

  • Early intervention. Physical therapists treat young children (birth to age 3) at risk for delays in the typical development of skills such as physical movement.
  • Developmental (or neonatal) follow-up clinic visits. Some hospitals have clinics for families to return to. This helps to ensure that infants at higher risk for developmental delays get the care they to help them reach developmental milestones.
  • Outpatient physical therapy. Infants with NAS may be referred to an outpatient physical therapy department specializing in pediatric rehabilitation. Pediatric physical therapists provide personalized treatment and fun playtimes designed to help babies safely progress in their development.

The Academy of Pediatric Physical Therapy Neonatal Special Interest Group contributed to this article.

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Ko JY, Patrick SW, Tong VT, Patel R, Lind JN, Barfield WD. Incidence of neonatal abstinence syndrome – 28 states, 1999-2013. MMWR Morb Mortal Wkly Rep. 2016;65(31):799–802. Free Article.

Patrick SW, Davis MM, Lehmann CU, Cooper WO. Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009 to 2012 [published correction appears in: Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009 to 2012. J Perinatol. 2015]. J Perinatol. 2015;35(8):650–655. Free Article.

Tolia VN, Patrick SW, Bennett MM, et al. Increasing incidence of the neonatal abstinence syndrome in U.S. neonatal ICUs. N Engl J Med. 2015;372(22):2118–2126. Free Article.

Kocherlakota P. Neonatal abstinence syndrome. Pediatrics. 2014;134(2):e547–e561. Article Summary in PubMed.

MacMullen NJ, Dulski LA, Blobaum P. Evidence-based interventions for neonatal abstinence syndrome. Pediatr Nurs. 2014;40(4):165–172, 203. Article Summary in PubMed.

Maguire D, Cline GJ, Parnell L, Tai CY. Validation of the Finnegan neonatal abstinence syndrome tool-short form. Adv Neonatal Care. 2013;13(6):430–437. Article Summary in PubMed.
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Lucas K, Knobel RB. Implementing practice guidelines and education to improve care of infants with neonatal abstinence syndrome. Adv Neonatal Care. 2012;12(1):40–45. Article Summary in PubMed.

Sweeney JK, Heriza CB, Blanchard Y; American Physical Therapy Association. Neonatal physical therapy; part I: clinical competencies and neonatal intensive care unit clinical training models. Pediatr Phys Ther. 2009;21(4):296–307. Article Summary in PubMed.

Velez M, Jansson LM. The opioid dependent mother and newborn dyad: non-pharmacologic care. J Addict Med. 2008;2(3):113–120. Free Article.

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